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General NPI Number Information
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NPI Number | 1861274979
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Entity Type | Organization
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Legal Business Name | JACOBUS FAMILY ENTERPRISES LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 728 HARVEST LN
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City | WASHINGTON TOWNSHIP
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State | OH
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Zip | 45458-4359
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Country | US
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Telephone | 219-765-3216
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Fax |
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Provider Business Mailing Address
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Address Line | 728 HARVEST LN
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City | WASHINGTON TOWNSHIP
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State | OH
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Zip | 45458-4359
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Country | US
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Telephone | 219-765-3216
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BRENT JACOBUS II
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Credential | MD
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Telephone | 219-765-3216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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